How to Stop a Panic Attack: In-the-Moment Steps and a Four-Week Plan

About this tool

How to stop a panic attack is a question of minutes: a panic attack is a surge of fear that peaks within about ten minutes and passes on its own, and the plan here is what to do inside that window. The honest answer is that you do not switch a panic attack off. You ride out a surge your body has already started, and it ends on its own. A panic attack is an abrupt wave of intense fear with physical symptoms: pounding heart, shortness of breath, chest tightness, sweating, shaking, nausea, dizziness, tingling hands, and a conviction that something terrible is about to happen. The DSM-5-TR describes the surge as reaching a peak within minutes. In practice, most attacks crest in about ten minutes and ease over the half hour that follows.

In the first sixty to ninety seconds, adrenaline and noradrenaline move through your system and your body does exactly what it is built to do under threat. Heart rate and breathing speed up. Blood is routed toward the large muscles, which is why hands and feet go cold or tingly. Digestion slows, which produces nausea. Breathing faster than your body needs lowers the carbon dioxide in your blood, and that alone causes lightheadedness, tingling around the mouth, and a feeling of unreality. Every sensation in a panic attack is an ordinary emergency response firing when there is no emergency. None of it is damaging, and nothing you do or fail to do makes it dangerous.

What turns one surge into attacks that keep coming is not the adrenaline. It is what you make of the sensations. David Clark's 1986 cognitive model of panic describes a short loop: a body sensation gets read as catastrophic, the interpretation raises anxiety, the anxiety intensifies the sensation, and the loop tightens within seconds. The usual readings are that you are having a heart attack, that you will faint, suffocate, lose control, or lose your mind. None of those is what is happening, but believing one of them is what converts discomfort into terror.

The second thing that keeps panic going is what you do to end it. Escape and safety behaviors work in the short run: leaving the store, sitting down, finding a window, carrying water or medication you never take, checking your pulse, only going out with someone. Each one ends the episode sooner and teaches you that you got through it because of the safety behavior rather than because panic attacks end by themselves. Over weeks, the list of places you can go gets shorter. This is how panic disorder and agoraphobia grow out of one bad afternoon.

So the in-the-moment plan is deliberately modest. Name what is happening in plain words: this is a panic attack, it peaks and passes, my body is not in danger. Stay where you are if you safely can, or step aside rather than going home. Do not take big deep breaths, which make hyperventilation worse. Lengthen the out-breath instead and let it be unhurried. Put your feet flat on the floor and name five things you can see. Then wait. Let the clock finish the work rather than trying to force calm, because trying to force calm is itself an alarm signal.

This page is the plan. The skills menu is separate: Panic Attack Coping Skills lists the individual coping moves to pick from, and Box Breathing gives you one paced pattern to practice while nothing is wrong. Choose one grounding move and one breathing move, write them into Part 1 below, and rehearse them on ordinary days. A skill practiced twenty times while calm is available during an attack. A skill read about once is not.

The longer plan is where the real change happens, and it is the opposite of avoidance. Cognitive behavioral therapy for panic, developed in Clark's model and in David Barlow and Michelle Craske's panic control treatment, pairs correcting the catastrophic interpretations with interoceptive exposure: deliberately bringing on the feared sensations through breathing through a straw, spinning in a chair, or running up stairs, so your body learns that a racing heart is uncomfortable rather than dangerous. The worksheet at Interoceptive Exposure Worksheet walks through that practice. Pompoli and colleagues' 2016 Cochrane network meta-analysis found CBT to be among the better-supported psychological treatments for panic disorder in adults, with the usual caution that trial quality varied and that no single treatment suits everyone.

One thing needs saying plainly and only once. Chest pain, pressure, or breathlessness that is new to you, that comes on with exertion, that spreads into the jaw or arm, or that arrives with fainting is not something to assume is panic. Call your local emergency number and get it checked. Panic attacks are common and so are hearts, and no self-help page can tell the two apart from a distance. Once a clinician has examined you and found nothing physical, you can treat recurrences as panic with far more confidence, which is itself part of the treatment.

Book an appointment rather than waiting it out if attacks come more than occasionally, if you are rearranging your life to avoid them, if you dread the next one most of the day, or if alcohol or other substances have become part of how you manage. Panic disorder is one of the more treatable anxiety conditions, often within eight to twelve sessions. This worksheet is an educational self-help plan for adults, not a diagnosis and not treatment. The Panic Disorder Test on this site can help you organize your own observations before that first conversation, and the Psychology.com therapist directory is free to search.

Reviewed by Michael Callans, MSW
Checked the in-the-moment steps, the description of panic physiology, and the line about new cardiac symptoms against current clinical guidance.

References

1. Clark DM. A cognitive approach to panic. Behav Res Ther. 1986;24(4):461-470.
2. Barlow DH, Craske MG. Mastery of Your Anxiety and Panic: Workbook. 4th ed. Oxford University Press; 2007.
3. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed., text revision. American Psychiatric Association Publishing; 2022.
4. Pompoli A, Furukawa TA, Imai H, Tajika A, Efthimiou O, Salanti G. Psychological therapies for panic disorder with or without agoraphobia in adults: a network meta-analysis. Cochrane Database Syst Rev. 2016;(4):CD011004.
5. National Institute of Mental Health. Panic disorder: when fear overwhelms. 2022. https://www.nimh.nih.gov/health/publications/panic-disorder-when-fear-overwhelms

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